Table of Contents

Chapter 5: "Secondary" Local Treatment

c. Prostatectomy Following Radiation Therapy

Traditionally, one of the key factors when deciding between prostatectomy and radiation for initial treatment was the issue of secondary local therapy. Because radiation therapy resulted in great damage to the genital area, curative surgical resection of the remaining prostate and/or tumor tissue was difficult.Many men therefore opted for surgery simply because it gave them the opportunity to be treated afterward with radiation therapy, should their cancer return.

With the advent of 3-D conformal radiotherapy, IMRT, and brachytherapy, local tissue damage is often kept at a minimum, and surgeons at some of the larger cancer centers have been seeing improved results with "salvage" prostatectomy.Much of the data suggest that men who had tumors that were considered potentially curable before radiation might do well with post-radiation surgery. But if the tumor had characteristics that suggest a higher likelihood of early disease recurrence, such as a higher Gleason score or spread to the lymph nodes or seminal vesicles, the surgery will probably offer little or no benefit.

Nevertheless, even under the best of circumstances, post-radiation surgery is a very difficult operation to perform and can result in significant urinary and erectile dysfunction, so few surgeons across the country perform it regularly. If you talk with your doctors about this treatment approach, be sure to carefully weigh all of the different factors that can play a role in determining whether this approach is right for you.